Aging: Common Problems and Care III:

Eyes, Ears, Taste, Smell, Reproductive and Endocrine Systems, Thinking and Emotions, Social and Legal Aspects


4 Inservice or Class Hours





At the end of this class, you should be able to:


1.    Discuss common problems of the eyes, ears, taste, smell, thinking and emotions, reproductive and endocrine systems and social and legal aspects of aging.


2.    Detail ways that you can prevent problems and care for the aging person with these problems and issues.




There are more aging people in the United States than every before. Many people say it is the “Graying of America”. We have learned a lot about these people and their needs in the last few years. Many old people are young in body and mind. All old people are not all the same. They are different. They all have different needs.


This class will teach you about some of the common problems and care that are NOT a normal part of aging. To learn about the normal changes, take our class called “Aging: What It Is and What It is NOT”.


You will learn about problems of the:


·         Eyes

·         Hearing

·         Taste and Smell

·         Thinking and Emotions

·         Endocrine (Glands) System

·         Reproductive System

·         Social Aspects

·         Legal Aspects




Some of the normal eye changes are:


·         Less able to focus.

·         The eyelids sag.

·         Eyelashes get thin, short and less.

·         A gray area around the edges of the cornea.

·         People become far sighted. They cannot see things that are close to them.

·         Lower eye muscle tone.

·         Less tears.

·         Decrease in eye muscle elasticity so things may be blurry to the person.


Some of these common vision problems are:


·         Diabetic retinopathy

·         Cataracts

·         Glaucoma

·         Age-related macular degeneration (AMD)


Diabetic retinopathy


Eye diagramThis is a complication of both type 1 and type 2 diabetes. The small blood vessels in the eye get damaged and may leak blood. It can be mild or a big problem that can lead to blindness. People with diabetes should have a complete eye exam at least once a year to find this problem since there are usually no signs until it becomes severe. The person may see floating spots of blood when it is severe. The nursing assistant must report any of these spots immediately to prevent further damage.


The treatment is burning the bleeding spots with a laser to prevent swelling and more bleeding,  or eye surgery.


All people, including the older person, who have vision problems, need assistance with many activities of daily living (ADL), including dressing, walking and eating. The need for safety, freedom from falls, and other injuries (cooking fires) are of highly important. 


A cataract is a cloudy lens in the eye. It can be in only one eye or in both eyes. A clear, not cloudy, lens is needed for us to see clearly. People may have brown areas of their eyes and they may see blurs because the lens is not clear. The risk is greater and greater as the person gets older and older. About ½ of people who are 80 years of age and older have them or have had them.


Some of the things that place a person at risk for them are:

  • diabetes
  • smoking
  • alcohol use
  • being in the sun too often

The most common signs are:

  • cloudy or blurry vision
  • glare (lights may look like they have a halo around them)
  • poor night vision
  • double vision
  • having to change ones eyeglasses often because the old ones no longer work

Many people need surgery (placement of a man made lens) when brighter lighting, new eyeglasses and other things like sunglasses do not correct the problem.


Again, the person has safety needs and may also need your help with their ADLs.



This eye problem can destroy the optic nerve to the point where the person loses some or all of their ability to see. It can affect one or both eyes. It happens when the fluid does not drain from the eye. As the fluid builds up in the eye, the pressure in the eye increases. This pressure ruins the optic nerve. It can be very serious and lead to blindness

The risk of this problem increases with age. It is one of the biggest causes of blindness in our country. African Americans, Mexican Americans, those over 60 years of age, and people who have had other family members with it, have the greatest risk for it.

Most people have no signs at all in the beginning of this problem. They see well. They have no eye pain. Later, they may lose their side vision. They can only see straight ahead. Like other eye problems, the eye doctor will perform tests to find out if the person has this, or another, problem.


There is no cure, to date, but the fluid and the pressure can be controlled with special eye drops. At times, the person may need laser surgery to control the build up of fluid and the pressure.


Nursing assistants and other members of the healthcare team should encourage their older patients to have regular, annual eye exams and to take all of their ordered eye drugs. They should also observe and report any changes in the person’s vision. Lastly, safety needs must be met and the person must be helped with their ADLs, as needed.


Age-related Macular Degeneration (AMD)


AMD affect the person’s straight ahead vision. The person may have trouble driving, reading and other things that require one to look ahead. For some people, the vision gets worse very slowly. For others, the vision gets worse very quickly.


It is the MOST common form of blindness for those people who are 50 years of age and more. There are 2 types:


·         Wet AMD

·         Dry AMD


People with wet AMD have blood leaking in the eye; people with dry AMD do not have blood leakage, but instead, the cells of their macular break down.


Some of the risk factors are:


  • Age. It is most common with older people, but it can begin in middle age.
  • Obesity
  • Race. White people are at more risk than African Americans
  • Smoking
  • Gender. More women get it than men.
  • Family. It tends to run in families.


The treatment of AMD can consist of laser surgery, drugs, vitamins and other things, depending on the type of AMD and the person.


Living with Macular DegenerationAs with all other eye problems, the nursing assistant should:


·         encourage their patients to have regular, annual eye exams;

·         remind the patient to take all of their ordered eye drugs;

·         observe and report any changes in the person’s vision;

·         provide the person with their glasses and any low vision aids that they have (magnifiers, special lights, etc.);

·         maintain safety; and

·         help the person with their ADLs, as needed.


Low vision

Many, many people lose all or part (low vision) of their vision every year. People with low vision have trouble doing everyday things even though they wear glasses, have surgery and use their eye drugs. Permanent vision loss is greatest among people who are 65 years of age and older.

People have low vision because of:


·         diabetes,

·         retinopathy,

·         cataracts,

·         glaucoma, and

·         macular degeneration among other things.


The primary sign is that the person is have trouble doing and seeing things like reading, cooking, selecting matching colors, reading signs, etc. People with low vision have physical and emotional problems. They may have trouble doing a lot of things. Their quality of life is not good. They are also more prone to accidents, including auto crashes and falls.


Special low vision programs help these people by giving them and teaching them how to use special things that help the person to read, write and do other things.  For example, they may get special lighting, magnifiers, large print reading materials, computers that talk, clocks and watches that talk and/or have larger numbers, etc.


You must give your patient these items and help them with these items when you care for people with these low vision devices.



Some of the normal ear changes are:


·         Thinner ear membrane.

·         Less able to hear higher tone as well as they did in the past.

·         Less ear wax in the outer ear.

·         The parts of the inner ear shrink.


Some hearing problems that are often seen in older people are:


·         Hearing loss

·         Tinnitus (ringing in the ear which results from hearing losses)

Hearing loss is a very common thing among old people. About 1/3 of people from 65 to 74 years of age have hearing loss. This % increases as people get older. About ½ of the people who are 75 years of age and older have a hearing loss. These losses are found more in men than in women.

Hearing losses can be small and minor; or they can be very severe and major. For example, a person with a small loss may not be able to hear a whisper. A person with a severe loss may not be able to hear a fire alarm or a smoke alarm.

Some hearing loses are permanent and cannot be fixed. Others can be cured with things like surgery.

This loss can result from:

·         Aging

·         An accident or trauma (head)

·         Some drugs

·         A disease like high blood pressure

·         Ear infections

·         Being around loud noises with out ear protection

·         Some drugs

Many people with hearing loss also have ringing, or hissing, in the ears although this can also occur with other problems such as a heart problem or a drug. Many people avoid other people because they are upset because they cannot hear what other people are saying. They may also be depressed. People with hearing loss also have safety needs. They may not hear smoke alarms, fire alarms, and cars as they are crossing a street. Many benefit greatly with a hearing aid and careful monitoring by the nursing assistant and/or family member.

In addition to hearing aids, people with hearing loss often use:

·         Telephone amplifiers

·         Phone flashing lights so the person knows that the phone is ringing since they cannot hear the ringing

·         Flashing smoke alarms


When you are caring for and communicating with a person who has a hearing loss and/or a vision loss, you should:

  • Give the person their eyeglasses and hearing aid, if they have one
  • Speak slowly and clearly while facing the person
  • Keep information simple
  • Use words that the person can understand
  • Use pictures and large print material when you can
  • Provide enough light if the patient will be reading
  • Keep sessions short
  • Repeat your communication as often as needed so that the patient can understand it and remember it
  • Allow enough time for the patient. Some patients need more time than others.
  • Make sure that the area or room is quiet
  • Allow the person to talk and ask questions
  • Include the husband, wife, and other loved ones in the communication and instruction process

Taste and Smell


Some of the normal taste and smell changes are:


·         Less taste buds

·         Less nose scent cells


Taste, smell and the look of foods all combine to make one’s taste and enjoy a meal. When the taste and ability is lost, the person may not have an appetite and they may not eat. We must make food as nice looking as possible so that these people eat. We must also make the meal time as pleasant as possible so that the person is willing to eat.


Loss of smell also places a person at risk because they may not smell a meal burning on the stove or a fire in their bedroom. Fire alarms and smoke alarms are needed.


Endocrine Glands


Some of these normal changes are:


·         Less growth hormone (less muscle mass).

·         Lower thyroid function.

·         Less insulin.

·         Less parathyroid function.


Some gland  problems that are often seen in older people are:


·         Diabetes

·         Slow thyroid



When food is eaten, it turns into sugar (glucose). This sugar is the "gas" for the body. Insulin is the "key" that pumps the sugar into the cells for energy. When this key is not present, the body runs out of energy because the body's "gas" is not being pumped to the cells. Insulin does not change sugar into body fuel when a person has diabetes.

It is normal for the sugar to go from the blood to the cells for energy. When the sugar goes to the cells, the sugar does not stay in the blood. People without diabetes keep a low level of sugar in the blood because it moves from the blood into the cells, as it should.

When a person has no insulin or not enough insulin, the sugar is not sent to the body cells from the blood. The sugar will then build up in the blood. The sugar level of the blood gets high for the diabetic patient. Too much sugar in the blood is called "high blood sugar". High blood sugar is a sign of diabetes.

When a person gets diabetes as an adult or an older person, they usually continue to make some insulin, but not enough to move all the sugar into the cells. These older people may be able to take care of their disease with diabetes pills, exercise and a good diet. They may be able to control this disease without having to take insulin shots like the child has to.

People with diabetes can develop blindness, poor vision, kidney failure, heart disease, strokes (CVA) poor circulation and other problems, such as foot infections, unless the diabetes is treated and kept under good control.

Health care workers should help these patients to control their disease. We must help them to eat a proper diet, to exercise and to follow their doctor's order for medicine, blood sugar testing and other care, including foot care, skin care and personal hygiene.

Some people with diabetes may have no signs at all. Others do. Some of the most common signs of diabetes are:

  • Feeling very hungry
  • Feeling very thirsty
  • Wanting to drink a lot of water
  • A dry mouth
  • The need to urinate often
  • Vision that is blurry and poor
  • Weight loss
  • Feeling weak and tired
  • A tingling and numb feeling in the feet and hands
  • Sores and cuts that do not heal at all or that take a long time to heal
  • Itchy skin in the groin or vaginal area of the body

No one knows for sure why or how people get diabetes, but there are some things that can increase the chance of getting it.

Some of these things are:

  • Family history. If a parent, grandparent, sister or brother has diabetes, the chances of getting diabetes is greater than it would be if you did not have this disease in your family. Family history cannot be changed.
  • Race. Asians, Hispanics, Native Americans and African Americans appear to get diabetes more than other groups of people. Race is another thing that cannot be changed.
  • Age. The chances of getting diabetes increase as people get older. Age and getting older cannot be controlled.
  • Being overweight. People that are overweight get this disease more than those people that are thin or with a healthy body weight. Most people that weigh too much can lose some weight when they eat a proper diet and they exercise every day. Being overweight can be changed. People that lose weight can lower their chance of getting diabetes.
  • Having high blood pressure. People with high blood pressure get diabetes more than those with a normal blood pressure. Many people can lower their blood pressure with stress management, exercise, a good diet and sometimes medicine.
  • Having high cholesterol and/or high triglycerides. Like high blood pressure, high cholesterol and high triglycerides increase the chances of a person getting diabetes. These high levels can also be changed with medicine, a good diet and exercise.
  • Alcohol use and smoking cigarettes. The chance of getting diabetes increases if a person smokes cigarettes or abuses alcohol. If a person does not use alcohol and does not smoke cigarettes, they are not as likely to get diabetes. We should tell patients to try to stop smoking. We should also help them to stop or decrease their use of beer, wine and other drinks that have alcohol.
  • Some viruses and other diseases. Some viruses and diseases place people at greater risk of developing diabetes. It is often not possible to avoid these diseases.

Nursing assistants and others who take care of people with diabetes should:

  • Help patients exercise on a regular basis, especially if they weigh too much, have high blood pressure or high cholesterol.
  • Assist their patients and residents to eat a good diet. Some may have a diet that is low in salt when they have high blood pressure.
  • Help their patients to use stress management tools such as sitting quietly and relaxing, deep breathing, prayer and meditation. Stress increases blood sugar levels. If you would like to learn more about stress and stress management, take the course entitled “Stress Management”. This course will help you and your patients to learn more about stress and how we can cope with it and live a better life.

The best way for the patient to control their diabetes is to follow the five keys of success. Nursing assistants, home health aides, personal care aides and other health care workers must help the person with these keys to success. The five keys of success are:

  • Diet
  • Exercise
  • Knowing what the blood sugar is
  • Personal care
  • Drugs when the MD orders them
In the hospital, nursing home, assisted living homes and the patient’s home care, we must make sure that the diabetic patient or resident:

  • Eats a good diet
  • Eats meals at the about the same time every day
  • Does NOT miss any of their meals
  • Has a snack at night if the doctor wants them to
  • Does NOT eat regular sweets, candy, cakes and cookies. Some doctors may allow the patient to have special sweets, candy, cakes or cookies with no sugar or only a little sugar.
Exercise makes us all of us feel healthy, happy and lively. It also helps us cope with stress. People with diabetes get the same results from exercise, but they also get another good benefit - Exercise lowers blood sugar.


Nursing assistants must do all they can do to make sure that the patient or resident exercises every day, as the MD orders. Nursing assistants should encourage the person to at least walk on a regular basis when the doctor orders it. Exercise on a regular basis is a very important activity of daily living. Some people may only be able to walk. Others may be able to run or ride a bike. Simple arm and leg exercises while sitting in a chair are good for elderly people who are not able to walk. Even these simple exercises are helpful.


Many nursing assistants are trained to take the blood sugar levels of diabetic patients. Others are not. If you are trained in taking blood sugars, you must be sure that you have done it correctly and documented or reported it.


Some patients in their home or an assisted living home may be able take their own blood sugar level alone or with a little help from the nursing assistant, home health aide or personal care aide.


Diabetic patients should:

  • Have their blood sugar level checked on a regular basis. Some people with diabetes have to check it two or three times a day. Others may only have to check it one time a day.
  • Know the signs of high blood sugar. The signs of high blood sugar are the same as the signs of diabetes that are listed above.
  • Know the signs of low blood sugar. People who have low blood sugar may sweat. They can also feel shaky, dizzy, tired or confused.

Too much food, candy, cakes and other sweats can cause high blood sugar. It can also occur when the person is sick, has an infection, is under stress or does not exercise, as they should. Low blood sugar can happen when the person does not eat enough food or is doing too much exercise.


Nursing assistants who take care of patients should know the signs of high blood sugar and low blood sugar. If a nursing assistant observes a patient with the signs of high or low blood sugar, it must be reported to the nurse immediately.


People with diabetes sometimes have poor blood flow to their feet. They are also more prone to get infections. Nursing assistants, home health aides and personal care aides must make sure that all patients, especially diabetic patients:


·         Are clean and well groomed

·         Have good skin care

·         Have good foot care. They should also wear shoes that fit well.


We should look at the feet of diabetic patients every day. If there is any redness or sores, it should be reported to the nurse immediately. At times, a person other than a nursing assistant or a home health aide must cut the toe nails of a person with diabetes. Check with the charge nurse before you cut the toe nails of a person with diabetes.

These patients and residents often take a diabetes medicine to keep their blood sugar down. If you work in an assisted living home or in the person's own home, you should remind them to take their medicine as the doctor has ordered.


Take our class called “Mini Med School: Diabetes” to learn more about this disorder.


Slow thyroid (hypothyroid)


Older people are more prone to slow thyroid gland function than other people. Some of the signs are:


·         Dry skin

·         Thin body hair

·         Depression

·         Lack of energy and feeling tired

·         Not able to handle the cold

·         Constipation


The MD will find it with blood tests. The person will get drugs to treat this problem.


Nursing assistants and other people who care for these people should:


·         Inspect the skin for any breakdown

·         Report any skin problems

·         Provide good skin care

·         Allow periods of rest

·         Clothe the person to keep them from feeling cold

·         Observe bowel patterns

·         Report any constipation


Reproductive System


Some of these normal changes for women (vagina) are:


·         Lower estrogen and lower moisture.

·         Low elasticity.

·         Less pubic hair.

·         Increase in alkaline fluid in the area.


Some of these normal changes for men are:


·         Lower testosterone.

·         Lower circulation to the penis.


Some of these problems that are often seen in older people are:


·         Breast cancer (women and men)

·         Prostate cancer (men)


Breast cancer

Most people think that only women get this cancer. Men get it too, but more women than men get it. In fact, one in eight women will find out that they have breast cancer. Older people are more at risk than younger people. It is one of the most common forms of cancer for women.

It can be very minor if it is found early. It can be major if it is found in the late stages.

The risk factors are:

·         Age. Most cases are found in people over 50 years of age.

·         Sex. Women get it 100 times more than men.

·         Family. It tends to run in families.

·         Race. White people get it more than black people.

·         Genes. Some have genes that make it more likely to get it.

·         Alcohol use.

·         Children. Women who have never had children or only one child are more at risk.

·         Hormones. People who have taken hormones for a long time after menopause.

·         Radiation.

·         Obesity.

·         Implants

Some people have no signs until they, or their MD, feels a lump or finds a lump with a mammo. Women over 40 should have a mammo every 1 to 2 years.

The person usually has no pain unless it is advanced. Other signs are:

·         Some change in the shape or size of the breast.

·         Tender nipple

·         Liquid from the nipple

·         Inverted nipple

·         Pitting or “orange peel” look of the breast

·         Bone pain

·         Breast pain

·         Swelling of the arm(s) next to the cancer

·         Weight loss

The treatment depends on the type and the stage of the cancer. Some of the treatments may include one or more of these things.

·         Surgery

·         Radiation

·         Drugs (hormones and chemo)

Some people get swelling of the area and arm after surgery.

A nursing caring for a person that has had breast cancer surgery should:

·         Encourage the person to keep mammo and MD appoints

·         Observe the area and the arm (swelling)

·         Keep the affected arm out of the sun or use sun screen

·         NOT take blood pressures on the arm


Prostate cancer

This small gland is under the man’s bladder and in front of the rectum. It is one of the leading cancers with men. Men 65 years of age and older account for more than 60% of all cases. It can be treated very well if it is found early.

The risk factors are:

·         Age. Most cases are found in men 65 years of age and older.

·         African American Men and Prostate CancerRace. It is more common in African American men than in any other group of men. It is least common in Asian and American Indian men.

·         Family. It tends to run in families.

·         Diet. High fats in the diet may lead to it.

·         Some other possible ones (lack of exercise, obesity, smoking, radiation, and  sexually transmitted diseases).

Early cancers usually have no signs. Later, some of the signs are:

·         Urine problems (frequent, urgent, not able to void)

·         Trouble starting to void

·         Trouble holding urine in

·         No erection

·         Pain with ejaculation

·         Blood in urine

·         Pain in back or hips

Men can be screened for it with an annual exam and PSA level in the blood.

The treatment depends on the type and the stage of the cancer. Some of the treatments may include one or more of these things.

·         Surgery

·         Radiation

·         Drugs (hormones and chemo)


Nursing assistants, especially those who care for older men, should observe the person’s urine patterns and report anything that is not normal (blood, frequency, etc.). They should also encourage the person to have their screening (exam and PSA) every year.


Thinking and Emotions


Not all old people have a mental problem or confusion. These things are NOT a normal change. Most are fine in terms of their thinking, learning and communication, but some have a disease or problem that affects these things. Some of these problems are things like Alzheimer’s and some drugs. It is also known that the personality of the person does not change as the person gets old. Most old people are happy with life for the most part. The person copes well if they have done so during their earlier life.


Alzheimer’s disease was covered in our class “Aging: Common Problems and Care II: Heart, Blood, Digestion (GI), Urinary Tract, and Nervous System”. If you would like to know more than this course covers, we suggest that you also take this class.


Now, we will cover communication with those that are confused since this is a major problem among older people.

Those who give care in the hospital, nursing home or in a person's own home communicate with their patients and residents many times every day. It is very important that we able to speak to and communicate with those that we care for, even when they have a problem with their thinking, or cognitive, ability.

The purpose of communication is to send a message from one person to another. This message can be sent with spoken words, by writing and with the person's body signs.

Communication can be:

  • Written,
  • Oral, and
  • Sent with body signs

Some examples of written communication are letters, notes and signs, like the ones you see on the street.

Some examples of spoken, or oral, communication are:

·         talking,

·         singing a song and

·         watching a television show.


Body signs also send a message. When a patient has a sad face and their teeth are tight together, they may be trying to tell you that they are in pain. When a person grunts or taps their table with their hand, they may be trying to get you to look at them.


Nursing assistants and others who take care of patients and residents also send messages with body signs. For example, when you stand in a patient's room with your arms crossed in front of you or on your hips while you tap your foot on the floor, you are telling the patient that you are in a hurry. You do not even have to say one word. The person may get your message and know that you are in a hurry.

Communication has a:

  • Message
  • A sender of the message and
  • A receiver of the message

Nursing assistants, and other people who take care of patients and residents, must be able to send and get messages from the people that they take care of.

The sender of the message must send the message in a way that the receiver of the message understands it. Our patients must be able to understand the message that we are trying to send to them.

We must also be able to understand a message that a patient or resident is trying to send to us. We must be able to understand what our patients are trying to tell us, even when they are confused and/or not able to speak. We must also be a good receiver of the message.


Sending a message to a confused, sleepy or unconscious person is not always easy. It takes special skills. It also takes special skills to send a message to a person that has a mental problem or illness.

It is also not easy to get, or receive, a message from a person that is confused, sleepy or not alert and oriented. This, too, takes special skills.


A cognitive impairment is a loss that makes it difficult for a person to send message and/or to get a message from another person. It makes it hard for us to communicate with the person with this kind of loss. The patient or resident is not able to think, speak, understand and/or remember. It can last for only a short time or it can last for a long time.

For example, some drugs can make a person not able to speak to you or understand what you are trying to tell them while they are taking a certain drug. For example, drugs that calm a person down can make our patients not able to speak clearly. This loss may be just for a short period of time. This person may be able to again think and speak clearly as soon as this drug has been stopped. People with Alzheimer's disease, on the other hand, have this loss for a long time. It will not go away. It will only great worse as the disease continues. (Take our class on Alzheimer's disease to learn more about it.)

Some groups of people who may not be able be able to speak and/or understand a message from a nursing assistant include:

  • Babies,
  • young children and
  • many old people.

These people may not be able to send a message to you. They may also not be able to get a message from you. For example, the older person may not be able to speak or understand your message. They may be confused and not able to communicate because of their old age, an illness or medicines. Young children and babies are also not able to talk with you. You must use special skills when the patient or resident does not understand what you are trying to say. At times, you should include the parent of the young child or the family members of an older person in your talks with the patient or resident.

Some other people who may not be able to communicate include those who have:

  • Alzheimer's disease and other forms of dementia. Many people with Alzheimer's disease and other kinds of dementia have trouble sending and receiving a message.
  • had a stroke or CVA. People that have had a stroke may have trouble thinking. Some may know what they want to say, but they just can not find the word that will send a message to other people. This is called expressive aphasia. They may also have trouble understanding a message from other people. This is called receptive aphasia.
  • a brain injury. People that have had an accident with a head or brain injury may have trouble both sending and getting a message. They may also be disoriented and even in a coma.

  • a mental illness. People with a severe mental illness may be unable to communicate because of their illness or as a side effect of the medication that they are taking.
  • a developmental problem. This kind of problem is found in about 1 in 10 families in our country. A developmental problem can happen before a person is born, when they are born or while they are growing up as a young child. Some of these people are not able to talk or understand what a person is saying to them.
  • severe sleepiness. It is difficult to communicate with people that are very sleepy and lethargic. We often see these kinds of patients in our hospitals and nursing homes.

·         a coma state. You should always speak to a person in a coma in the same way that you would speak to them when they are awake, however, they may not understand what you are saying and they will not be able to tell you what they want or need.

You must use simple, plain words that a person can understand when you communicate. Do not use words like "hospital", "NPO", "ambulate" or "void" if the person does not know what these special healthcare words mean. You should say, "You can not eat or drink anything after 12 midnight", instead of saying "NPO". You may want to ask the person if they "would like to walk", instead of asking them if they "would like to ambulate". Also, use the word "urinate" or show the male patient the urinal, instead of using the word "void" unless the person understands that word.

Some of the other things that you should do to help when you communicate with a person who is cognitively impaired are:

  • include the family and friends in the communication when a patient or resident is not able to understand what you are trying to say;
  • ask the family and friends how the person can be helped to communicate with you;
  • speak in a plain way, using words that are simple. For example, instead of asking if the person is hungry, ask, "Would you like to eat some eggs?";
  • talk to patients and residents in a place that is quiet and that does NOT have a lot of distractions. Turn off the radio and TV while you are talking to the person, after you ask them if you can;

  • make sure that the person can see you. Turn on the lights if the room is too dark;
  • discuss one thing at a time;
  • repeat the message as often as needed;
  • ask one question at a time and listen to or observe for the answer;
  • draw pictures or write things down for the person if this helps them understand what you are trying to say;

  • let the patient draw a picture or write things down for you if this makes it easier for them to tell you what they want or need;
  • ask "yes" or "no" questions. For example, if you want to know if a patient wants to eat fruit, ask "do you want an apple or a pear?", instead of "do you want to eat a piece of fruit?";

  • use real objects whenever you can. For example, show the person the real object, like an apple, if you are asking the patient if they would like to eat it.

  • speak slowly and in a clear way;
  • talk with a low pitch, not with a high pitched voice;
  • face the person that you are talking to;
  • make eye contact with the person
  • listen to the person;
  • look at the person's face. Is the person trying to tell you something? Do they look like they are in pain? Are they holding a part of their body, like their hand or their head? Do they look sad? Do they look angry?;

  • give the person their eyeglasses and hearing aid, if they wear them;

  • always show respect and caring; and
  • communicate with touch and a calm voice when you want to tell a person that you care and they can not understand the spoken word.

Communication is a very important part of patient care. You must use the special skills described in this class when your patient has a cognitive impairment so that messages can be sent and received.


Social Needs


All people, including older people, have social needs. Old people often have things that interfere with these needs. For example, the person may have low vision and not be able to drive. This person is then not able to drive to the store or the doctor’s office. They may also not be able to get to their favorite group, church or friend’s home for a visit. A person who has had a CVA may no longer be able to walk safely down the hall to see a friend in a nursing home or assisted living home and they may no longer be able to enjoy things like golf and fishing. An older person may be separated from their family when the older person lives in Florida and their children live in New York. These people have social needs.


Many in the health care team can help these people. For example, an MD may be able to help the low vision person with eye glasses or surgery. A social worker may be able to get a person “Meals on Wheels” and/or low cost cabs to the MD’s office. A recreation therapist may help the person to enjoy other activities and exercises when the person may no longer to able to play golf or to go out on the lake. Nurses may help the person to communicate with family who are far, far away.


The nursing assistant can help these older people by following the orders and suggestions of other members of the health care team. For example, they can call the low cost cab to transport the person to the MD office. They may help the person to do wheelchair exercises and they may help the person to phone their family members. It is very important to give the person as much independence as possible and to assist them only in the areas with which they need help. This increases the person’s self esteem and quality of life.


Legal Needs


Some of the special legal issues that are often seen in older people are:


·         Maintaining rights and dignity

·         Advanced directives

·         Health care proxy

·         Power of attorney

Maintaining Rights and Dignity

All people, patients and residents have basic rights. We all must know about these rights when we work in health care. We must know what these rights are so we can make sure that all of our patients and residents have these rights while we provide care to them.

All patients and residents have a right to:

  • Respect and dignity
  • Privacy
  • Confidentiality
  • Freedom from abuse and neglect
  • Control over their own money
  • Have their personal property
  • Know about their medical condition and treatments
  • Choose their own doctor(s)
  • Make decisions about their medical care
  • Competent care
  • Religious and social freedom
  • Accurate bills for services given
  • Complain and be heard

All people have the right to respect and dignity. We must:

  • Speak to our patients with respect. We must always talk to all of our customers, families, fellow workers and visitors in a kind, helpful and polite way.
  • Use good communication skills.
  • Call people by their name. Do not call people 'momma', 'poppa', 'sweetie' or 'honey'. These names do not show respect.
  • Let the person talk about their feelings. Give them the time to talk with you. Do NOT look like you are in a hurry. Always make the time to talk to a person with respect.
  • NEVER treat an adult like a child. Do NOT talk 'baby talk' with adults.
  • Help patients and residents so they can be as independent as they can. Help them with their self-care and activities of daily living.
  • Make sure the person looks good and is clean. We must make them look clean, shaved and without dirty finger nails.
  • NEVER allow a person to stay wet with urine, dirty or with a bad odor. These things take away a person's dignity.
  • Give people as many choices as possible. Let the person choose unless their choice can cause them harm or can harm others. For example, let a person pick a fresh fruit for their snack. Let the resident pick out the activities they want to attend over the next week. Let them pick out their own clothing for the day.
  • Keep patients and residents covered so others cannot see them when they are getting a bath and getting nursing care. Pull the curtains around the bed.
  • Make people feel very special each and every time you are with them.

Treat and speak to others, as you like to be treated.

People do not lose their right to privacy because they are old or in a hospital or nursing home. They also do not lose this right when they have home health care. Patients and residents have a right to:

  • Talk privately with family, friends and other patients or residents. Do not interfere. Do not listen to these conversations. Give people a quiet place to talk in private.
  • Personal things. NEVER open a patient's closet or pocketbook without getting their permission. If you are in the person's home, do NOT enter any area or open any closets unless the person tells you that you can.
  • Knock on the patient or resident door before walking in. Their room is their own private space, just like yours is in your own home. Do NOT enter their space unless they allow you to or there is an EMERGENCY.
  • Personal privacy. Provide personal privacy when bathing or caring for a patient.

Patients and residents have a right to have personal information kept secret from all other people, except those that are giving her care. NEVER talk about one of your patients with friends, neighbors, other patients or residents.

Some confidentiality rights are found in laws. For example, it is not legal to tell anyone that a patient has AIDS/HIV.

Health care workers, including nursing assistants, should NEVER tell a person's diagnosis or condition to anyone that is NOT caring for the patient. Do NOT talk about patients in halls or coffee shops. You never know who is listening!

  • All patient charts and records must also be kept in a safe place so that people not caring for the person cannot read them.
  • Do NOT talk about your patients when you go home. It is against the law to tell your family member or neighbor that 'Mr. B., my patient has AIDS'.
  • Do NOT talk about your patients with other patients or unknown people that have called the nursing station. You do NOT KNOW who is at the other end of the telephone.

All humans should be free from abuse and neglect. Many elders, children and young adults with physical or mental problems are at risk for abuse and neglect. Family members, care givers, health care workers and other members of a community can abuse or neglect others.

Child abuse can happen in the child's own home and it can occur in another place like a day care center or group home. Elder abuse can also occur in the home and in a place, like an assisted living, group home or long term care nursing home.

Abuse is defined as 'maltreatment'. Elder abuse affects older adults. A person that the elderly person trusts usually causes elder abuse. Their child, spouse, a nurse, nursing assistant or home health aide can abuse them. Child abuse is the maltreatment of infants and young children. Parents, relatives and day care providers are sometimes guilty of child abuse.

Anyone can be abused. Men, women, adults, children and people of all ages can be abused.

Nursing assistants and other health care workers must, by law in many states, immediately report all cases of suspected elder abuse and child abuse. And, of course, we must NEVER, NEVER abuse anyone!

If you THINK that someone is abusing or neglecting a patient or resident, REPORT IT. You do NOT have to be certain! Report it if you think it may be happening.

There are several types of abuse. Abuse can be physical, emotional or mental, sexual or financial.


·         Physical abuse. Physical abuse is the use of a physical force. A punch, slap, push or pinch is physical abuse. Elders are often physically abused with rough treatment. Grabbing a person out of their bed is physical abuse. Signs of physical abuse are skin tears, bruises and broken bones.

·         Mental abuse. Mental abuse causes the person to have mental pain. Yelling and name calling are examples of mental abuse. Elders are mentally abused when they are treated like a child or locked in a room. Threats are also mental abuse. Mental abuse can cause very serious mental pain and fear. Signs of mental abuse are fear, crying and sadness.

·         Sexual abuse. Sexual abuse is sexual contact of any kind without the consent of the other person. Touching, fondling and rape are examples of this type of abuse.

·         Financial abuse. Financial abuse is the improper or illegal use of the victim's money. Taking money from an elder to use for something they do not want is an example of this type of abuse.


Neglect is a little different from abuse. Neglect does NOT involve an act that is wrong. Neglect is NOT doing something that should be done. Men, women and people of all ages can also be neglected.


Neglect can be physical, mental, or financial.

  • Physical neglect. Examples of physical neglect are not giving the person the food or physical care they need.
  • Mental neglect. Ignoring a person is an example. Another example of mental neglect is abandoning a person who is afraid of being alone.
  • Financial neglect. If any elderly person lives in the home with a daughter and the daughter does not let the person buy eyeglasses with their own money, this is financial neglect.

Patients and residents who are able to make decisions can, and should, have control of their money. They should be allowed to decide how to spend their money even if we do not think it is a smart thing to do. For example, if your patient wants to buy 1,000 lottery tickets a week, they should be allowed to do it if they have the money.

When a person is not able to make decisions, another person may have legal control over the person's money.

Residents and patients should also be able to have and use their personal property. If, however, these things can harm to the person or others, they can't be used.

Many assisted living facilities and nursing homes let residents have their own furniture, television sets and radios. These things help the resident feel at home and comfortable. Some things, though, like radios and televisions have to be checked for safety before they are used.

Patients and residents must know about their care and the choices they have about the care they receive. Doctors, nurses and others must tell all patients and residents about their condition and care in words that the person can understand.

They must be told how their medicines and treatments can help them. They must also be told how their medicines and treatments may cause some bad side effects. They should also be told about other treatments that they can choose from if they do not like the choice that the doctor is telling them about.

Nursing assistants may be asked to give information to a patient or resident. When you do, talk to the person in simple, words that the person can understand. If the person asks you a question that you cannot answer, report this question to the nurse.

Patients and residents must be able to choose their own doctor. Other people do not have the right to make this choice for them if they are able to make a decision.

For example, an administrator who wants Doctor K. kept busy in the nursing home cannot pick Dr. K. to care for all the residents. Each resident has the right to use the doctor that they choose. Their choice may or may not be to use Doctor K.

Patients and residents must know about:

·         their condition

·         the benefits and risks of a treatment before they can consent, or agree to it

·         other things that can be done instead of one particular treatment

After the person knows these things, the person can decide what they want and what they do NOT want. The choice belongs to the patient or resident whenever they are able to make a decision. The doctor, nurse or family member CANNOT make the choice when the person is able to make his or her own decisions.

Doctors and nurses teach patients and residents about their condition and treatments. Nursing assistants may be asked to give instructions to patients. They should also explain all the care that they are giving.

We must remember to talk to patients, family and visitors with simple words so that they can know what we are trying to tell them. For example, do not tell a person that they are 'NPO' after midnight. Tell them that they 'can not have any food or drinks after midnight'.

Patients and residents also have the right to safe and high quality care. Good care cannot be done unless nurses, doctors, nursing assistants and all other health care workers are able to do the right thing in the right way.

Everyone must know how to provide safe patient care in the correct way. If you are not sure of how to do something, STOP. Get the nurse and ask the nurse to teach you or to help you with it. Do NOT ever do anything unless you are sure that you can do it the right, or correct, way. Safe patient care is a RIGHT.

All Americans have the right to freedom of religion. They also have the right to be with people they choose to be with.

  • Do NOT force anyone to go to a religious activity unless they want to
  • Help people go to the religious groups they choose
  • Encourage them to choose the groups and activities that they want
  • Help them get to any social, recreational and/or patient rights groups that they want to go to

Laws state that all patients and residents have a right to a bill that has ONLY those things that the person actually got. These laws also say that everyone should have their bill explained to them if they want to.

Nursing assistants do not give patients their bill but there are some things that nursing assistants can do.

  • NEVER charge a supply, such as a urinary drainage bag, to a patient that will not be getting it
  • Tell the nurse if a person wants to speak to someone about their bill

All patients and residents have a right to complain. All concerns, questions and complaints must be heard and listened to.


Some hospitals have patient advocates who listen to these questions, concerns and complaints. Many nursing homes have ombudsman who speak to residents about their complaints, concerns and questions. Patient advocates and ombudsmen help our customers with their concerns.


Notify the nurse if your patient or resident has a complaint or a concern. The nurse may then speak with the patient and call the patient advocate or ombudsman to solve the problem. Our goal is patient satisfaction and customer service.


Most complaints can be avoided with patient care and good customer service. Use good customer service skills. However, if one does come up, do NOT argue with a patient or resident. Get help from the nurse.


Advanced directives


All patients and residents that are capable of making a decision must be able to do so.

  • A person can choose what they want and what they do NOT want. If a person refuses care, do NOT force them. Some people do not want a lot of medications or treatments like CPR. Others choose to have CPR and medications. Know your patients and residents. Respect and carry out their wishes.
  • If a person has enough thinking ability (competence) to make a decision, their decision must be respected. Family members, nursing assistants and all others MUST respect these decisions, even if we do not agree with them.

People of all ages should put these wishes into a legal document called Advanced Directive. Then, when they are NOT competent to make decisions, this document is used for decision making.


Health care proxy


If there is something that the person has not put in their advance directive and the person is not competent to make a decision, the person may make a person a decision maker, or proxy, for them.


For example, the person is in a coma and a decision to place, or not place,  a feeding tube has to be made. A feeding tube was not covered in the advance directive. If the person has a proxy, it is the proxy that makes that decision. The next of kin makes the decision, or the “power of attorney”, when this happens.

Power of attorney (POA)

NOT all POAs are the same. They differ from state to state and from person to person. It can be very limited or very wide sweeping. For example, a blind, older person may have a POA that will only sign legal documents that the person cannot see. Or, a person may have their POA make ALL decisions whether or not they are competent and others may only have the POA make some, or all, decisions when they are not competent to do so. The patient is the ultimate decision maker even after they are no longer competent. Advance directives, informed health care proxies and POAs must act in the PERSON’S interest only, not their own.



National Institute on Aging, U.S. National Library of Medicine
National Institutes of Health, and U.S. Department of Health & Human Services.
(2011). NIH: Senior Health.

US Administration on Aging. (2010). A Profile of Older Americans: 2010.


Word, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Mosby, Inc.


Copyright © 2011 Alene Burke